CCM Practice Exam Flashcards
1
Q
The grief reaction and psychological exhaustion experienced by the health care professional that occurs during helping interactions is called
A
empathy fatigue
2
Q
After assessment, the planning component of case management includes
A
developing realistic and measureable goals.
3
Q
According to the Americans with Disabilities Act (ADA), an “otherwise qualified” person is one who is:
A
capable of performing essential job functions with or without accommodations.
4
Q
Research indicates that the best treatment for depression is a combination of:
A
psychotropic medication and psychotherapy
5
Q
Managed care plans that reimburse specialty physicians under capitation pay providers based on:
A
a fixed payment per member per month.
6
Q
Managed care plans that reimburse specialty physicians under capitation pay providers based on:
A
a fixed payment per member per month.
7
Q
Preferred Provider Organizations (PPOs) are formed to:
A
contract with providers for reimbursement discounts.
8
Q
The medical home model is a:
A
source of primary health care
9
Q
In somatoform disorders, there are:
A
physical symptoms for which no organic cause can be found.
10
Q
Disorientation in an elderly client without obvious organic cause could be considered a symptom of:
A
overmedication.
11
Q
Health maintenance organizations (HMOs) are healthcare systems that are:
A
responsible for financing and delivery of health services to an enrolled population.
12
Q
In addressing the issue of elder abuse, it is crucial for the case manager to:
have the client removed from the place of residence where the abuse is occurring.
confront the abuser and refer him/her to appropriate help.
report the abuse to law enforcement.
evaluate for potential risk and intervene to reduce or eliminate the risk.
A
evaluate for potential risk and intervene to reduce or eliminate the risk.
13
Q
A principle of life care planning is:
collecting documentation from doctors.
providing for needed quality of care.
receiving referrals from attorneys.
obtaining clients
’
tax documents.
A
providing for needed quality of care.
14
Q
Which of the following assessment tools would be most useful when evaluating whether a geriatric client will need additional care giving support?
Barium swallow study.
Verbal Descriptor Model.
Activities of Daily Living Scale.
Braden Scale.
A
Activities of Daily Living Scale.
15
Q
In the presence of language barriers, the case manager should:
employ a professional interpreter.
utilize pictures or diagrams.
transfer the case to a bilingual case manager.
use family members as interpreters.
A
employ a professional interpreter
16
Q
The overall goal of negotiation is to:
obtain a quality product.
gain acceptance of a rate change.
achieve a win/win scenario for all parties involved.
get the lowest price.
A
achieve a win/win scenario for all parties involved.
17
Q
In order for a child to receive an assistive technology device through an
Individual Education Plan (IEP), the device must be:
recommended by the treating physician.
educationally necessary.
federally defined as an assistive device.
unaffordable for the family.
A
educationally necessary
18
Q
A network of services focused on outreach, advocacy, and helping individuals live as independently as possible is a(n):
work adjustment program.
community support program.
disability management program.
inpatient rehabilitation program.
A
community support program
19
Q
Health maintenance organizations (HMOs) are healthcare systems that are:
responsible for developing evidence-based health research.
used to help injured workers receive care for their injuries.
jointly owned and operated by hospitals and their affiliated physicians.
responsible for financing and delivery of health services to an enrolled population.
A
responsible for financing and delivery of health services to an enrolled population.
20
Q
One goal of effective disease management is to:
diagnose chronic conditions.
promote workplace safety.
promote physician-directed programs.
prevent exacerbations and complications.
A
Prevent exacerbations
21
Q
The first step in the problem-solving process is to:
define the problem.
establish goals.
identify potential problems.
specify the consequences.
A
define the problem
22
Q
The preferred level of care for a patient who requires intravenous antibiotics administered four times a day for a two week period and cannot afford nor safely manage this care alone at home is:
a skilled nursing facility.
an acute care hospital.
an assisted living facility.
home care with a visiting nurse.
A
a skilled nursing facility
23
Q
An unexpected occurrence not related to the natural course of illness that results in death, serious physical or psychological injury, or permanent loss of function is called a:
sentinel event.
variance.
complication.
catastrophic event.
A
sentinel event
24
Q
A dimension to the health belief model affecting decision-making and motivation is:
perceived opportunities.
perceived benefits.
response to symptoms.
response to medical regimens.
A
perceived benefits
25
The case manager's documentation of patient and family teaching based on the patient's condition and needs should include:
problem-oriented goals.
expected length of service.
potential treatment risks.
cost of service.
problem-oriented goals.
26
In case management, the process of creating formal written statements of goals and responsibilities with the client is called:
leadership.
contracting.
negotiation.
motivation.
contracting
27
A primary component of effective negotiating is:
having an agenda.
knowing the answer.
maintaining eye contact.
practicing active listening.
practicing active listening.
28
A major reason for nursing home placement of an Alzheimer's patient is the:
lack of available financial resources.
ability to perform activities of daily living.
lack of available community resources.
lack of a willing caregiver.
lack of a willing caregiver
29
The benefit plan which offers the client the highest degree of freedom in choosing a health care provider is a:
health maintenance organization (HMO).
traditional indemnity plan.
preferred provider organization (PPO).
managed indemnity plan.
traditional indemnity plan.
30
One factor that increases the client's participation in rehabilitation is:
the physician's orders.
financial constraints.
the employer's policies.
family-centered interventions.
family-centered interventions.
31
One factor that increases the client's participation in rehabilitation is:
the physician's orders.
financial constraints.
the employer's policies.
family-centered interventions.
family-centered interventions
32
Which of the following is an accurate statement describing advance directives?
The patient's durable power of attorney is included in the directive.
The patient is given an opportunity to direct his/her own care.
The patient's signature is required as a condition of care.
A lawyer must execute the patient's directive.
The patient is given an opportunity to direct his/her own care.
33
Item 21 of 100
Mark item for review
The main purpose of client involvement in developing a rehabilitation plan is to:
meet regulatory requirements.
organize the delivery of services and control costs.
improve precision in achievement of goals.
set long-term goals.
improve precision in achievement of goals.
34
The assessment of variances for each case type and acting immediately to control for these variances are ways in which case managers impact:
usual, customary, and reasonable (UCR) rates.
provider-client communication.
the cost of care.
the standardization of case management practice.
the cost of care
35
Which member of the multidisciplinary team is the primary provider of medical care services?
Occupational therapist.
Physician.
Nurse.
Case manager.
Physician
36
In working with diverse populations, case managers should:
understand the client's cultural perspective.
ignore differences in order to make the client feel at ease.
mainstream the client through education as soon as possible.
emulate the cultural differences themselves.
understand the client's cultural perspective.
37
All definitions of case management include responsibility for:
coordination of services.
improved access to services.
decreasing costs.
discharge planning.
coordination of services
38
For case managers participating in an acute care setting, critical pathways provide:
care at the family's request.
care per the insurance carrier.
care per doctor's orders.
standardized patient care techniques.
standardized patient care techniques.
39
Capitation is a method of:
risk sharing.
fee sharing.
point-of-service.
fee-for-service.
risk sharing
40
Two essential components of a risk management program are:
loss control and loss prevention.
fall prevention and fall preparedness.
risk identification and compliance.
application of techniques and controls.
loss control and loss prevention.
41
Preferred Provider Organizations (PPOs) are formed to:
offer Medicare clients a wider range of services.
contract with providers for reimbursement discounts.
eliminate the need for precertification of services.
avoid the need for accreditation by the Utilization Review Accreditation Commission (URAC).
contract with providers for reimbursement discounts.
42
An important criteria for all powers of attorney is that the:
person designated to receive the power of attorney must be a lawyer.
power of attorney, document, or process requires a court order and a physician's examination.
signer has the right to terminate the power of attorney.
person designated in the power of attorney must reside in the same state as the signer.
signer has the right to terminate the power of attorney.
43
In writing a case management report, the information must:
be balanced to present an accurate picture.
include subjective assumptions.
document all work done in detail.
use conversational vernacular.
be balanced to present an accurate picture.
44
Which tool is commonly used to assess the diagnosis of depression in clients with chronic illness?
Short Form Health Survey (SF-12)
Depression Control Test (DCT)
Patient Health Questionnaire (PHQ-9)
Patient Activation Measure (PAM)
Patient Health Questionnaire (PHQ-9)
45
Root Cause Analysis (RCA) is a component of a(n):
utilization review.
critical pathway.
outcome measurement.
sentinel event assessment.
sentinel event assessment.
46
An active process in which individuals take responsibility for gathering information about themselves, occupations, and the labor market is:
work adjustment.
situational assessment.
job analysis.
career planning.
career planning.
47
Advocating for early referral to case management services:
enhances the client's access to appropriate cost-effective services.
eliminates risk behaviors affecting wellness outcomes.
decreases the use of multiple resources.
facilitates provider control of treatment modalities.
enhances the client's access to appropriate cost-effective services.
48
Federal law requires mandatory disclosure of:
human immunodeficiency virus (HIV) or acquired immune deficiency syndrome (AIDS) status.
drug or alcohol abuse.
mental health/psychiatric care.
child abuse.
Child abuse
49
Use of a family member as the primary caregiver for an individual with a chronic illness may result in:
social isolation for the caregiver.
decreased stressors for the family.
consistent involvement of all family members.
increased social support for the family.
social isolation for the caregiver.
50
Case managers who carry only a specific type of caseload are referred to as:
specialists.
generalists.
brokers.
experts.
specialists
51
When the case manager provides a concurrent review to a third party payer, the review should be based on:
established criteria.
the assigned diagnostic related groups (DRGs).
the managed care contract.
the length of stay.
established criteria.
52
In psychiatric and chemical dependency case management, the client's diagnosis may be derived from the:
Diagnostic and Statistical Manual of Mental Disorders' multi-axial approach.
Monthly case management updates.
International Classifications of Diseases' coding system.
Functional Impairment Measurement.
Diagnostic and Statistical Manual of Mental Disorders' multi-axial approach.
53
A common category of outcome indicators is:
satisfaction.
social.
family.
rehabilitation.
satisfaction
54
A cultural blind spot is:
the inability to recognize differences in values and beliefs of others.
an area in one language that cannot be expressed well when translated into another language.
the belief that some populations are inherently superior or inferior to others.
the belief that one's own culture is the most valid.
an area in one language that cannot be expressed well when translated into another language.
55
According to the Americans with Disabilities Act (ADA), an "otherwise qualified" person is one who is:
perceived as having an impairment.
trained to perform highly skilled functions.
capable of performing essential job functions with or without accommodations.
capable of performing marginal job functions with accommodations.
capable of performing essential job functions with or without accommodations.
56
During the vocational assessment interview, the rehabilitation counselor should:
listen intently to the client's response.
interpret the client's feelings.
allow the client to guide the interview.
ask close-ended questions.
listen intently to the client's response.
57
A case manager providing crisis intervention to a client would:
refrain from attempting to influence the client.
sharply delineate the problem by focusing on the most pressing aspect.
give the client a number of options.
get the client to talk about their childhood experiences.
sharply delineate the problem by focusing on the most pressing aspect.
58
Eligibility for federally-funded health insurance under Medicare includes:
low income and limited assets.
retirement at age 60.
recipients of Social Security Disability Insurance (SSDI) benefits for two years.
children between ages 18 and 21.
recipients of Social Security Disability Insurance (SSDI) benefits for two years.
59
In conducting an initial interview, the case manager should remember that the foundation of effective communication lies in:
reflective listening.
encouraging two-way conversations (e.g. dialogues).
asking questions.
focusing on feelings.
reflective listening.
60
Documenting cost savings from case management interventions may be accomplished by:
completing a cost-benefit analysis.
obtaining family input.
preparing monthly status reports.
participating in a discussion with the referral source.
completing a cost-benefit analysis.
61
Ergonomics has been defined as the scientific study of how a workplace and the equipment used can best be designed for comfort, efficiency, safety, and:
productivity.
sustainability.
scalability.
risk management.
productivity
62
Research indicates that the best treatment for depression is a combination of:
short term disability leave and psychotherapy.
social service consult and medication.
psychotropic medication and psychotherapy.
medication and short term disability leave.
psychotropic medication and psychotherapy.
63
The most common method of assessing the effectiveness of case management is:
length of recovery.
savings reports.
client/employer satisfaction.
decreased litigation costs.
savings reports
64
The doctrine of informed consent:
supports that the patient has a right to determine what shall be done with his/her own body
ensures adequate disclosure of patient information.
protects the healthcare provider while administering the appropriate treatment.
protects the healthcare provider from malpractice.
supports that the patient has a right to determine what shall be done with his/her own body
65
The grief reaction and psychological exhaustion experienced by the health care professional that occurs during helping interactions is called:
empathy fatigue.
validation.
secondary trauma stress.
post-traumatic stress disorder.
empathy fatigue
66
Upon completion of the initial evaluation with the injured worker, the case manager proceeds to:
contact the spouse or significant other of the individual.
authorize medical services on the individual's behalf.
develop a rehabilitation plan based upon the needs of the individual.
initiate retraining services.
develop a rehabilitation plan based upon the needs of the individual.
67
One of the components of disease management is:
databases are used to direct medical treatment.
the Orem model is used to identify chronic illness.
identification of rates of complication.
population identification processes.
population identification processes.
68
Cultural competence is the process by which a case manager:
understands all major cultural groups and their family systems
immerses oneself with the language and beliefs of the client.
conducts a self-examination of his/her own prejudices and biases toward other cultures.
strives to achieve the ability to effectively work within the cultural context of the client.
strives to achieve the ability to effectively work within the cultural context of the client.
69
The first client contact affords an important opportunity for the case manager to:
introduce vocational rehabilitation services.
begin building rapport with the client.
give approval for medical services.
confront the client.
begin building rapport with the client.
70
A proactive trigger for early case management case selection is:
discharge planning.
health insurance access.
A proactive trigger for early case management case selection is:
```
discharge planning.
health insurance access.
diagnosis.
hospital readmissions.
.
hospital readmissions.
```
Diagnosis
71
The medical home model is a:
case management approach to improving access to care.
source of primary health care.
method for improving adherence to physician orders.
multi-disciplinary treatment plan in the home setting.
source of primary health care.
72
Case management organizations are frequently challenged to manage caseloads for effective, quality practice. Which of the following is a major consideration?
Client cooperation.
Nurse to physician ratio.
The case management model.
Case management certification.
The case management model.
73
An element of legal consent is:
confidentiality.
consideration.
capacity.
coercion.
capacity
74
Which of the following case management interventions may result in hard cost savings?
Investigation of benefit coverage.
Education on treatment side effects.
Facilitation of medication refills.
Negotiation on equipment purchases.
Negotiation on equipment purchases
75
When speaking with a client's family, the case manager will:
assess relationships and roles.
express sympathy for the client.
limit discussion to the needs of the client.
identify potential conflicts among the health care team.
assess relationships and roles.
76
Which service is classified as a post-acute level of care?
Telementary care.
Inpatient medical care.
Hospice care.
Emergency room care.
Hospice care
77
What is the best method of documentation to ensure the safety of the client, maximize communication, and improve care?
Narrative progress notes.
SOAP charting.
Multidisciplinary care plans.
Electronic health record.
Multidisciplinary care plans.
78
The act of giving people the control, accountability, and freedom to act on what they know is:
transformation.
autonomy.
empowerment.
collaboration.
empowerment
79
To receive Social Security disability benefits, one criterion is that the disability:
is incurred eight or more years after the death of a fully-insured spouse.
is expected to last, or has lasted, at least one year.
prevents return to employment of choice.
remains unclassified by a physician.
is expected to last, or has lasted, at least one year.
80
Health literacy is defined as:
the ability to read health care instructions.
the skills necessary to understand health care related documentation.
the capacity to obtain, process, and understand basic health information.
an individual's knowledge of their health conditions.
the capacity to obtain, process, and understand basic health information.
81
An example of a reasonable accommodation is:
providing a medical examination for the individual with a disability so that the employer will know what environmental changes are needed.
requesting that the individual with the disability obtain a physician's medical document stating the accommodation needed.
modifying existing facilities to be readily accessible to an individual with a disability
assigning only 25% work hours to the individual with the disability.
modifying existing facilities to be readily accessible to an individual with a disability
82
To be eligible for Supplemental Security Income (SSI), a client must be:
able to demonstrate financial need.
deemed to have a permanent disability.
over age 65.
legally blind.
able to demonstrate financial need.
83
Work hardening following an on-the-job injury consists of:
a test performed by the treating physician to determine physical strengths.
the final stage of physical therapy in preparation for a return to work.
an exercise program offered by the employer to prevent re-injury.
a re-training program offered by state and local agencies.
the final stage of physical therapy in preparation for a return to work.
84
Disorientation in an elderly client without obvious organic cause could be considered a symptom of:
normal aging.
change of environment.
overmedication.
malnutrition.
overmedication
85
An example of an operational variance is:
a health care provider's practice pattern.
the breakdown of a piece of equipment.
a patient refusal to allow a procedure.
a complication of the patient's medical condition.
the breakdown of a piece of equipment.
86
Item 39 of 100
Mark item for review
The principle of autonomy occurs when an individual:
is informed of his/her benefit limitations.
is regarded with a paternal perspective.
determines his/her own actions.
refuses to participate in the decision-making process.
determines his/her own actions.
87
Claims processing organizations that are utilized by self-insured entities to handle claims paperwork, investigate losses, and pay provider bills are called:
external payer associations.
third party administrators (TPAs).
claims management organizations.
loss management administrators.
third party administrators (TPAs).
88
A characteristic of critical thinking is:
flexibility.
introspection.
conformity.
stereotyping.
flexibility
89
Interdisciplinary care that aims to relieve suffering and improve quality of life for patients with advanced disease is called:
rehabilitative.
complementary.
alternative.
palliative.
palliative
90
A successful case management model focuses on:
the continuum of care.
reduction of length of stay.
diagnostic data.
acute care episodes.
the continuum of care.
91
The repeated use of a drug to avert a physical withdrawal reaction is:
substance tolerance.
physical dependence.
substance abuse.
psychological dependence.
physical dependence
92
Hospice care promotes
Quality of life
93
When a patient has two or more sources of health insurance, the reimbursement will follow the rules of:
coordination of benefits.
bundling.
spend down.
Consolidated Omnibus Budget Reconciliation Act (COBRA).
coordination of benefits.
94
A key principle to do no harm underlying case management practice is:
nonmaleficence.
veracity.
beneficence.
autonomy.
nonmaleficence
95
The presence of conflicts that arise when competing standards of right and wrong apply to a specific situation is a(n):
practice standards conflict.
moral dilemma.
ethical dilemma.
cultural bias.
ethical dilemma
96
Therapeutic recreation specialists function primarily by:
using leisure activities to restore health.
working exclusively with catastrophic injuries.
being supervised by a physical therapist.
working in community settings.
using leisure activities to restore health.
97
An important consideration in addressing polypharmacy is to:
ensure a complete disclosure of all medications being utilized.
recommend use of generics to reduce costs.
ensure that all medications are being taken as ordered.
encourage complete compliance with the medication regimen.
ensure a complete disclosure of all medications being utilized.
98
Prospective review is often a condition specified in the contract between the managed care organization and the:
hospital.
employer.
employee.
client.
hospital
99
Managed care plans that reimburse specialty physicians under capitation pay providers based on:
provider qualifications and performance.
a relative value scale.
a fixed payment per member per month.
the services billed minus a withhold.
a fixed payment per member per month.
100
In somatoform disorders, there are:
recurrent obsessions that do not respond to treatment.
symptoms that develop after an injury.
manic and hypomanic episodes.
physical symptoms for which no organic cause can be found.
physical symptoms for which no organic cause can be found.
101
An intervention to improve medication adherence in the elderly population could be:
not telling the patients of potential side effects.
keeping all medications in original containers.
spacing medication times throughout the day.
using a memory aid (e.g. taking medication with meals).
using a memory aid (e.g. taking medication with meals).
102
A residential complex that includes independent living, assisted living and nursing home care is known as a:
continuing-care retirement community.
congregate housing facility.
group home.
board and care home.
continuing-care retirement community.
103
After assessment, the planning component of case management includes:
designing a reporting system.
evaluating durable medical equipment needs.
arranging regular monthly updates.
developing realistic and measureable goals.
developing realistic and measureable goals.
104
In planning for a patient's discharge, a hospital discharge planner can facilitate a referral for a skilled home care visit by a:
family caregiver.
volunteer.
home health RN.
physician.
home health RN.
105
Subacute rehabilitation offers services that include:
skilled nursing, physical therapy, and restorative care.
custodial care, skilled nursing, and hospice.
a structural environment with one-on-one supervision.
assistance with activities of daily living, medication supervision, and intensive procedures.
skilled nursing, physical therapy, and restorative care.
106
What type of review evaluates and approves requests for days beyond the initial approval?
Concurrent.
Retrospective.
Prospective.
Urgent.
Concurrent
107
Providing culturally relevant care is sometimes best left outside the realm of case management. A case manager:
should request reassignment of the case to a case manager of the same cultural/religious background.
should decline to discuss such issues with a client when a conflict arises.
should ignore cultural/religious issues as not being part of case management interventions.
must be aware of such conflicts and be prepared to not fully understand but be non-judgmental and supportive.
must be aware of such conflicts and be prepared to not fully understand but be non-judgmental and supportive.
108
A goal of accrediting agencies and consumer advocacy groups is to ensure:
the least restrictive care and setting.
quality care and safe medical services.
the most cost-effective care.
a comprehensive provider directory.
quality care and safe medical services.
109
Implementation of the case management plan includes:
coordinating and developing the treatment plan.
gathering initial information about the client.
linking the client's needs with appropriate services.
the limitation of benefits and cost control.
linking the client's needs with appropriate services.
110
Case Management Society of America (CMSA) Standards of Practice for Case Management define:
relationships with providers.
treatment protocols.
relationships with clients.
clinical practice.
relationships with clients.
111
Managed care is a system that provides
a variety of techniques intended to reduce the cost of providing health benefits and improve the quality of care ("managed care techniques") for organizations that use those techniques or provide them as services to other organizations ("managed care organization" or "MCO"), or to describe systems of financing and delivering health care to enrollees organized around managed care techniques and concepts ("managed care delivery systems").
112
After reviewing a client's treatment records, the payer approves the claim. This is an example of which type of review?
Retrospective is reviewing health care costs after services are rendered.
113
Usual, customary, and reasonable (UCR) charges are those that are normally:
The phrase “usual, customary, and reasonable” (UCR) refers to the base amount that third-party payers (including insurance carriers and employers) generally use to determine how much will be paid, on behalf of an enrollee, for services that are reimbursed under a health insurance policy or health plan. Generally, payment for health care services is based on UCR rates: most coverage is only a percentage of what is determined to be UCR and therefore what is approved under the terms of the contract. For example, if the plan covers 80 percent of UCR charges and the enrollee is responsible for the remaining 20 percent, the plan will actually pay 80 percent or less of what is charged by the provider. As a result, the enrollee will be responsible both for the remaining 20 percent and for the difference between what is charged by the provider and what the plan considers UCR.
114
An indirect technique used by managed care organizations (MCOs) to control costs is:
Preventive services indirectly are aimed at preventing complications and outcomes of disease to control costs.
115
Under Medicare reimbursement, the Prospective Payment System (PPS) provides that
A method of determining reimbursement to health care providers based on predetermined factors, not on individual services.
116
An indirect technique used by managed care organizations (MCOs) to control costs is:
Preventive services indirectly are aimed at preventing complications and outcomes of disease to control costs.
117
Managed health care organizations utilize case management as a mechanism to:
Managed care organizations (MCOs) use case management to coordinate complex medical care. Historically, MCOs focused on small patient populations with catastrophic conditions that consumed disproportionate health services dollars. This type of case management is known as large case management.
118
Medicaid is an entitlement program to provide medical assistance to low-income individuals who are eligible under programs such as:
Medicaid provides medical assistance to those who fit into certain groups that falls under AFDC programs. TANF falls under AFDC.
119
In the managed care arena, a pharmaceutical formulary is a:
a listing of drugs intended to include a large enough range of medications and sufficient information about them to enable health practitioners to prescribe treatment that is medically appropriate. Hospitals maintain formularies that list all drugs commonly stocked in their pharmacies. Third-party organizations such as insurance companies usually maintain formularies that list drugs that the company will cover under plan benefits. See also compendium, United States Pharmacopeia.
120
Managed care organizations have classified a very high-cost patient as:
A high-cost patient is when medical usage of the patient is at a much higher rate than that of his or her peers.
121
For a client to receive a higher level of benefits from a point-of-service plan (POS), referrals must be directed by the:
It is necessary for the primary care physician to make the referral in a POS plan. The other options are not characteristic of POS plans.
122
The fundamental goal of managed care programs is to contain the costs of health care by:
This is a definition and common practice of managed care.
123
Benefits for services not ordinarily covered by a client's insurance policy may be paid through the use of:
This is the definition of extra contractual benefits.
124
Managed care organizations have classified a very high-cost patient as:
A high-cost patient is when medical usage of the patient is at a much higher rate than that of his or her peers.
125
Incorrect For a client to receive a higher level of benefits from a point-of-service plan (POS), referrals must be directed by the:
It is necessary for the primary care physician to make the referral in a POS plan. The other options are not characteristic of POS plans.
126
One strategy for cost containment in the private insurance industry is to:
Transitioning care is one of the components of the care continuum.
127
The fundamental goal of managed care programs is to contain the costs of health care by:
This is a definition and common practice of managed care.
128
Correct Benefits for services not ordinarily covered by a client's insurance policy may be paid through the use of:
This is the definition of extra contractual benefits.
129
The purpose of a viatical settlement is to:
Life insurance payout while person with terminal illness. Money is to be used for care and services.
130
Businesses that sell pre-paid health care services to consumers are known as:
This is the standard definition of an HMO.
131
A term used to describe the insurance to cover losses incurred that exceed a specific dollar threshold is:
This the definition of reinsurance.
132
Traditional fee-for-service indemnity:
This is standard practice of traditional fee-for-service indemnity plans.
133
The primary source of information for establishing reimbursement for home health services is called:
Home health assessment OASIS determines functional status, service use rates, and categorizes each patient into a payment group.
134
Guidelines for the provision of Medicaid coverage are:
State and federal governments jointly determine the guidelines for Medicaid.
135
Drug addiction includes which of the following components?
Physical dependence
Psychological dependence
Physiological dependence
136
If the case manager identifies a client with a low literacy level, an effective technique to assess understanding is:
The "teach-back" method is a communication strategy that is an effective way to evaluate understanding. A client completing a questionnaire, participating in group discussions, or listening to paraphrased statements will not establish as to whether a client understands. The "teach-back" method requires the client to teach the case manager what was learned/understood in a document.
137
A key factor in an individual and family's successful adjustment following a crisis is:
Social supports are necessary in order to help a family successfully cope after a crisis.
138
A concern in using the Internet as an immediate source of medical information is the:
Consumers must think about the validity of the information that is received from the Internet. Whether or not clients can access online sites or how quickly or cheaply is not as important as to the quality of information that is received.
139
Which of the following is the process of adopting the characteristics of another culture?
This is the accepted definition of assimilation.
140
The most severe form of alcohol withdrawal is:
Delirium tremens have a mortality rate of 10%; cardiac arrhythmia can occur but is not the primary or most severe symptom.
141
Causes of elder abuse include caregiver stress and:
The abuser's dependence on the elder is one of the factors that can lead to abuse.
142
A treatment for people with substance dependency in acute withdrawal is:
Detoxification allows for medical monitoring or management of symptoms of withdrawal.
143
In a cross-cultural situation, the case manager must demonstrate:
Open-mindedness demonstrates multicultural competency.
144
In dealing with patients with chronic illness, it is important for the case manager to:
Self management of the patient with a chronic illness will result in better outcomes.
145
Family adjustment to an individual's disability will be determined by the:
Families will respond to an individual's disability based on who they are and their circumstances, not how well the case manager explains information, duration, or teaching provided.
146
A commonly used instrument to assess geriatric cognitive status is the:
This is a commonly used instrument to assess cognitive function.
147
Interventions for ensuring the safety of older adults at risk or experiencing abuse and neglect include referrals to social services, health and mental health services, and:
Social services
148
The goals of health promotion programs are to support wellness, decrease health risks and prevent:
Promoting healthy behaviors helps maintain optimal levels of wellness, change lifestyles, and move towards a state of optimal health.
149
In order to be specific and accurate in recognizing the feelings of a client from another culture, the case manager must:
Understanding cues and signals is necessary in order to understand or recognize differences with clients of different cultures. Case managers should not encourage assimilation or get the client to relate to personal values.
150
It is crucial for a pediatric case manager working with a medically fragile child to establish:
Rapport, plan of care,
151
When a client is from an ethnic minority group, it is important to:
Different cultures have different health beliefs. A case manager must understand that a cultural construct does not influence every interaction. The cultural assessment is essential for the case manager to understand where the client is coming from.
152
Which complementary and alternative therapy has been widely used in substance abuse treatment?
Acupuncture is an established alternate therapy to substance abuse.
153
The presence of an addiction that coexists with another psychiatric disorder refers to:
This is the definition of dual diagnosis.
154
The primary reason for noncompliance with outpatient services is the:
Without transportation, clients will not follow up. Limited availability is not the primary reason for noncompliance. Case managers need to be aware of the reasons clients will be noncompliant.
155
Environmental control units assist persons with disabilities by:
This is the definition of assistive devices.
156
A program that allows an injured employee to work in the community in a real life work situation is a:
This is the definition of a trial work program.
157
State workers' compensation laws generally provide which of the following benefits?
Loss-of-earning benefits are accepted benefits regarding workers' compensation.
158
An intervention used with a client participating in a supported employment program is:
This is a common concept regarding supported employment. Case managers must assist clients with their progress, not put services on hold.
159
A prosthetist/orthotist constructs highly individualized prostheses based on prescriptions from the:
This is a definition of what physiatrists do - they specialize in physical medicine.
160
Clients with a visible disability who are in a job interview:
Clients should focus on what they can do and discuss how they can perform the job they are applying for.
161
For a client with a spinal cord injury, race, level of education, age, pre-injury employment, and level of injury are all factors in predicting:
A prediction of the return to work is a key component of vocational rehabilitation.
162
The process of examining available jobs including hiring trends, salary levels, and employment availability is a:
This is the definition of a labor market survey.
163
In order to be truly effective, assistive technology should be considered during:
Per best practices of assistive technology, assistive technology should be considered during all phases.
164
When assessing a chronically ill client's employability, one negative indicator is the client having a(n):
Goals must be realistic, measureable, and achievable.
165
An underlying theme of supported employment for persons with head injuries is:
This is the definition/common theme of supported employment.
166
Ongoing adjustment to a changing workplace, disability, and environmental factors after a chronic illness is a process of:
This is a definition of career adaptability and a common disability case management concept.
167
An example of a job modification is:
Reduced work hours is the only component of job modification that is listed. The other options are not examples of how to adjust a job to meet client needs.
168
Which of the following is a common ergonomic problem?
Repetitive motion injuries are common ergonomic problems while the others are not. Ergonomics is the study of how a workplace is designed for comfort and safety.
169
The modification of a position by eliminating non-essential tasks or reassigning tasks to others who have the relevant skills and interests is:
This is per the ADA definition of job restructuring.
170
Which of the following should be specifically considered in vocational planning and evaluations of work environments for clients who have multiple sclerosis (MS)?
Temperature extremes are an important consideration for MS patients. Case managers need to know what the environment will be because the patient could decompensate at temperature extremes.
171
A treatment goal for chronic illness that is often overlooked is the:
Productivity is an important consideration in young/middle-aged adults.
172
A job seeker with a disability can be hampered in finding work because:
Teaching/assuring development of the skill of job searching is an element of case management for the disabled worker.
173
An issue for employment among people with rheumatoid arthritis is:
Rheumatoid arthritis is a fatiguing illness that may cause clients to not be functional 100% of the time and require more breaks.
174
The critical vocational consideration for epilepsy is the:
Specific disease-related functional limitations need to be acknowledged.
175
The agency that sets performance standards for and accredits health care organizations, case management programs, and Internet health care sites is:
This is the definition of what URAC does.
176
When making a decision to discharge a client from an inpatient facility, the most important thing a case manager can document is:
These are basic concepts of discharge planning. Discharge should only occur if the patient has met discharge criteria.
177
Documentation of case management activity should include:
Observations, decisions, actions, and outcomes are components of documentation while the other options are not.
178
Beliefs and attitudes that provide action in everyday life are known as:
Values are the beliefs of culture and family modified by experience and providing action in everyday life.
179
When considering reasonable accommodations, the Americans with Disabilities Act (ADA) requires the employer to consult with:
The ADA requires employers to provide reasonable accommodations so that employees with disabilities can enjoy the "benefits and privileges of employment" equal to those enjoyed by similarly-situated employees without disabilities. Benefits and privileges of employment include, but are not limited to, employer-sponsored: (1) training, (2) services (e.g., employee assistance programs (EAP's), credit unions, cafeterias, lounges, gymnasiums, auditoriums, transportation), and (3) parties or other social functions (e.g., parties to celebrate retirements and birthdays, and company outings).(44)If an employee with a disability needs a reasonable accommodation in order to gain access to, and have an equal opportunity to participate in, these benefits and privileges, then the employer must provide the accommodation unless it can show undue hardship.
180
Tape recording of communications between a certified case manager and a client is:
Federal Privacy Act
Title III of the Omnibus Crime Control and Safe Streets Act of 1968, amended by the Electronic Communications Privacy Act of 1986 ("ECPA"), and also known as the Federal Wiretapping Act, makes it unlawful for an individual to intentionally intercept or disclose any "wire, oral or electronic communication." 18 U.S.C. §§ 2510 et seq. The Act contains an exception and allows for electronic monitoring "[w]here such person is a party to the communication or one of the parties to the communication has given prior consent to such interception. 18 U.S.C. § 2511(2)(c).
This is a standard expectation/concept of confidentiality.
181
A person with quadriplegia files suit against the case manager alleging a breach of duty which has resulted in an actual loss to the client. Most likely, the client is charging the practitioner with:
This is the definition of malpractice.
182
An integral component of an organization's quality improvement plan is:
Risk management is a necessary component of quality improvement because it is used to prevent and control loss and to ensure quality assurance.
183
The term used to refer to an individual as a surrogate decision maker for situations in which the client becomes incompetent or is unable to make his/her desires known to health care providers is:
Durable power of attorney is a document executed to declare the authority to make health care decisions if the declarant becomes incompetent or incapable.
184
What are the two basic steps to the informed consent process?
These are the defined requirements of the informed consent process. Patients must indicate that they agree to any procedure.
185
Case managers may decrease legal risk by:
Carefully monitoring a patient's condition is a common risk management principle.
186
Under the Employee Retirement Income Security Act (ERISA) of 1974, self-insured plans are:
This is a standard component of ERISA.
187
A planned strategy and activity that modifies a maladaptive behavior or state of being and promotes growth and change is:
This is the definition of intervention.
188
The case manager's best defense when being sued for negligent referral is that the:
This is a common risk management principle.
189
Laws concerning advance directives:
The majority of states have enacted legislation authorizing various guidelines for use of DNR orders.
190
Which of the following medical records may require a court order for release?
These are examples based on established confidentiality standards.
191
If a client decides to leave a facility against medical advice, the first thing a case manager should do is:
If the patient is leaving against medical advice, the patient could harm self. The case manager needs to inform the patient and ensure understanding; the case manager needs to assess cognitive faculties of the patient and ensure the patient can make good decisions.
192
The purpose of standards of practice is to establish: This is a basic case management concept: the standard definition of what standards of practice establish to guide/define case management practice.
the standard definition of what standards of practice establish to guide/define case management practice.
193
Safeguarding the client's privacy is an example of:
This is the definition of confidentiality.
194
To avoid negligent referral liability, the risk management procedure that the case manager should put in place is to:
The quality assurance step is to prevent case managers from being liable; this is a basic step of case management.
195
Measuring success in the case manager's role is important and can be accomplished by utilizing which of the following?
Length of stay (LOS), patient and staff satisfaction, clinical outcomes, and costs of care are benchmarks that can be used to measure success and failure.
196
A communication strategy that decreases a case manager's legal risk is:
By obtaining a thorough assessment, the case manager has clear documentation to use as proof if necessary.
197
To maximize patient commitment to the plan of care, the case manager should:
When a patient is involved in setting goals and developing a plan, the patient is more likely to demonstrate a commitment to that plan.
198
Steps in the problem-solving process:
The problem-solving process is not linear, should not create conflicts, and involves more than just managerial staff. When solving a problem, consequences must be considered in order to help determine what is the best solution.
199
As defined by Case Management Society of America (CMSA), which of the following is a direct clinical outcome of case management?
Increased client knowledge is a direct clinical outcome of case management.
200
Documentation of a discharge plan should include the:
An important part of discharge coordination planning is that the patient must first agree to the plan.
201
The phase of the case management process in which the case manager determines the client's eligibility for services is:
This is the definition of an assessment phase.
202
When an older adult client decides to move, the first transitioning task for the geriatric case manager is to determine the client's required living environment and:
The level of care must always be established and appropriate for the client.
203
An effective negotiation requires a(n):
Others' needs must be acknowledged in order to ensure effective communication. All relevant information needs to be given in an open, non-confrontational approach.
204
Which of the following nonverbal behaviors would be demonstrated by a case manager with effective listening skills?
Leaning towards the client indicates an interest in what the client is saying.
205
The advantage of case managers using a method to assign cases based on physician specialty is:
Consistently using methods ensures that plans and processes are followed the same way over time.
206
A method of resolving conflicting needs that satisfies all parties by redefining the issues is:
All parties must work together/collaborate to effectively solve problems; this is a basic communication skill.
207
The first step in outcomes management is to:
Without data, trends, variances, or changes cannot be identified.
208
When assessing clients with chronic medical problems for health care needs, the case manager should consider that which of the following diagnosis is often unrecognized?
Assessment for comorbidity is part of the case management process.
209
A key to quality assurance for case management is:
Quality must first be defined in order to determine whether it has been met.
210
Client advocacy for individuals with disabilities can include:
Advocacy is a common case management principle. Advocacy is about arguing for a cause, idea, or policy.
211
A comprehensive and dynamic approach to estimating the long and short-term needs of a catastrophically injured person is called a:
A life care plan is used to assess the overall needs and goals of a catastrophically injured patient.
212
Attending to what a client is saying, both verbally and nonverbally, is an example of:
This is a definition of active listening and reflects good communication skills/techniques.
213
In providing a cost-benefit analysis of case management services, which of the following is an example of a hard savings?
A hard/soft savings comparison is key to evaluation. Hard savings relate to cost reductions.
214
In outcome-driven case management, the case manager must be concerned with:
Outcome measurements are the end results of outcome case management.
